Physician to Meta-Physician

THE FACEBOOK PARADOX -- Friends Without Benefits

I was beginning to think that I was the only one on the planet who felt that the Facebook phenomenon was strange.  Of course I am on it, but barely. I just find the entire format rather chaotic.  I'm not sure what to do with "friends of friends" who want to be my friend.  I don't know why everyone has to share all their personal information with everyone else.

What happened to intimacy?  What about keeping private matters for a handful of real flesh and blood friends?  With all that in mind, I found an article by Michael Austin in Psychology Today quite fascinating.  Titled "Quitting Facebook Could Make You Happier",  he refers to studies which have shown that "people on Facebook believe that others have happier lives than is actually the case."

Essentially it means that individuals are comparing their own lives with the "Facebook" version of the lives of others.  Facebook becomes a vehicle by which people can put their best face forward and even exaggerate their own "wonderful" lives.  Others become dissilusioned, jealous and otherwise miserable.

In a study at Utah Valley State University, students who actually interacted in person with other students were less likely to think others have it better.

Real life teaches us that no one's  life is as ideal as we might imagine.  Perhaps that truth is more apparent when we interact with others in person.  We can perceive facial expressions,  watch body gestures as we share the truth behind our personal joys and sorrows. 

We quickly come to understand that no one gets through life untouched by some degree of suffering and that the shared human experience makes us all grateful for what we have and humbled by the opportunity to experience the gift of being alive.

When we interact in person with others there is a sense of shared space which confirms intimacy and our common humanity.  It is the source of what may evolve into friendship as we used to understand the word.

END OF LIFE STUDIES -- For Doctors and Everyone Else

FYI--doctors are not particularly good at dealing with death and dying. 

That may surprise some.  There may be an assumption that doctors are somehow more familiar with death, perhaps trained to deal with all its implications and ramifications than the average person and, therefore, more comfortable discussing and dealing with it--but for the most part, this isn't the case. 

There have been attempts by some medical schools to introduce the topic and encourage open discussion.  But I haven't seen much evidence among my colleagues that it has worked.

Doctors are trained to diagnose, treat and "defeat" disease states.  Death is seen as the ultimate enemy. We are not comfortable with it.   Doctors are trained to be defensive about death.  Society has raised expectations of health care to such an extent that death is viewed as the consequence of medical mistakes, a potential  malpractice case.  Our litigious society, fueled by avaricious attorneys has inflamed the issue of death to such an extent that doctors overdo defensive practices (despite Obama's clams).

Doctors are afraid to openly discuss with the patient and their family when  further aggressive treatment will only cause suffering and not change anything.  Palliative approach or even Hospice consultation should be suggested by doctors.  Rarely does that occur.

Doctors will often insert their own personal/religious beliefs into the discussion with families about end of life care.   Some of the motivation, sad to say, may be financial.  Instead, they should allow family members to address these issues with their loved ones who may, themselves, be conflicted about the best approach.  Doctors should be open to discussing medical realities.  Offering false hopes by suggesting risky testing or therapies is inappropriate.  Honesty is needed as well as being open to answering family concerns.

I have been consulted about inserting endoscopic feeding tubes (PEGs) in patients who are at the end of life.  Family members worry that their loved ones are "hungry" and starving when they stop eating.  I point out that this is the natural consequence of the body "shutting down".  Force feeding would actually make their loved ones uncomfortable.  It will change nothing.

 

The issue becomes one of judging the quality of the individual patient's life and their prognosis.  The patient's wishes should be reviewed.  Family members should not attempt to change advanced directives because it makes them uncomfortable.

I often advise families to do what is in their loved one's best interest, not their own.  They may want them to continue to stay alive, but at what cost?  Quality of life IS important.  When it is gone it is time to offer comfort and compassion.

Palliative care committees need to proliferate.  The public needs to face end of life issues with open dialogues involving religious leaders, ethicists, physicians, social workers and well known cultural icons.

Death should not be regarded as the unspoken enemy.    It depends on the particular situation.  A sudden death of a young otherwise healthy individual is always tragic. But for those been blessed with relative longevity and facing a progressively worsening medical condition,  death represents the end of suffering and the ultimate fate of all of us.

ANXIETY -- ."...ALWAYS AND ABSOLUTELY PERSONAL..."

Is this the "age of anxiety" ?  Daniel Smith asks this question in his NY Times piece. http://opinionator.blogs.nytimes.com/2012/01/14/its-still-the-age-of-anxiety-or-is-it/?emc=eta1   His is a personal question since he reveals much about his inner psychological demons.  He admits to struggling with chronic anxiety for years, writes about the proliferation of xanax prescriptions and gives some historical perspective on our age.

What strikes me as most meaningful about his piece are his observations that anxiety has become culturally accepted as a "condition".   He points out that the openness of our awareness may actually feed the phenomenon.   He also points to the "recursiveness" of anxiety.  By that he means that a single worry can build, gain strength through our focus and obsessive preoccupation with it.  Anxiety can be the monster that builds itself like a golem and therefore  become something  self-sustaining.  In other words, if you expect to be overwhelmed by it--it will happen.

He speaks of disempowering anxiety--to let it go.  Anxiety, worry, fear are always subjective.  That does not diminish or deny the real life events which may precipitate it.  But when it takes a on a life of its own and becomes debilitating, then out of pure survival instincts, we need to toss it away.

I like the analogy of fishing.  Catch and release.  Our fears/anxieties/worries will arise in our consciousness.  That is a certainty.  We should hold them, even examine them.  We acknowledge that they are there for a reason.  They may be there to teach us about some real dangers. Then recognizing that it is unhealthy to keep them,  toss them back.

Is this easy? Of course it isn't.  But it may be reasonable to meditate on this analogy of catch and release before we need it. 

Then, just perhaps, when we feel the bite of anxiety on the line, we can call it forward and use it.

RADIO MESSAGES FROM MOMS -- Two ADCs

The following are two ADCs (after death communication) or ("visits from heaven").  They are poignant and powerful bits of evidence for survival of consciousness after death.

The most recent was told to me by a young woman who works in my surgicenter.  She had been particularly stressed lately due to a variety of personal problems.  Major decisions had to be made involving her own life, there were also medical problems in the family and she was still mourning her mother's death.

The following morning after a particularly resetless night, she jumped into her car and turned on the radio.  Her mother's favorite song was playing.  Even more remarkable, she told me, was that the radio was tuned to an AM station.  She only listens to FM stations and no one had access to her car overnight.

She had no doubt that this was a message from her mom.  She immediately felt at ease and was able to put aside much of what was disturbing her.  She felt her mom was giving her a sign that everything would be OK.

It was a healing experience for her.

This was similar to another experience I had heard of from a patient of mine several years ago.  His case was even more remarkable and dramatic. 

He described how his deceased mother appeared to him and held a conversation with him.  He was going through a horrific personal crisis involving the use of drugs and was severely depressed.  He was alo estranged from his only sister.  The message from his mother was to try to turn his life around and to contact his sister.  He asked his mother for a sign that would convince his sister that this "meeting" had actually occurred.  She would automatically assume it was some drug induced hallucination. 

His mother asked him to tune into the radio after she was gone.  He did so and heard the old Helen Reddy song "You and Me Against the World".

He did call his sister who was immediately dismissive of him.  He proceeded anyway to explain his visitation, including the song that had played on the radio.  His sister was literally in shock.  "Don't you know what that song means?", she asked.  Her voice was quivering.  He admitted that he did not.  "That was the song that mom and dad always sang together when they were at my house".

My patient subsequently straightened out this life.  He and his sister eventually reconciled.

THE HALVAH UNVEILING

It is less than a year since my father Frank's death and burial.  In traditional Jewish fashion an "unveiling" of his memorial plaque occurred yesterday January 8th.

The usual prayers include the Mourner's Kaddish and the traditional El Malei Rachamim first instituted after the slaughter of Jewish communities by Crusaders in the 12th century.  There was the recitation of the 23rd Psalm and a reading from the Book of Ecclesiastes.

After a cloth was removed from the newly created plaque with my father's name, the date of his birth and death, we each placed a small stone on it, to note our presence there.

But we had a small surprise for the guests and my Dad as well.

 My son had returned from California for a visit and the day before we both walked to the famed deli Barney Greengrass in Manhattan. Known for their lox and smoked fish we both took note of the blocks of marble halvah covered in chocolate.

I'm not sure if he said it first or not but we both knew we had to buy a chunk of it--not only for ourselves but for  Dad.

It was a transgenerational favorite among the men in our family. For three generations of Hodes men--halvah was the ultimate desert.

A sweet preparation of ground sesame seeds and paste with vanilla, chocoalte "marble" and covered with milk chocolate, it must be pound for pound the most dense  of calories and carbs imaginable.  But it was traditional, not only among Jews, but Poles,Turks, Arabs,  Russians, Greeks, Bulgarians, Indians, etc. etc.

In fact it must be the food that is ultimately served at a Middle Eastern peace conference (if one ever happens).

And so we secretely brought the block of halvah to the cemetery and surprised everyone by offering it to all who cared to partake.  

And then the final ceremony--a small piece was set on my Dad's plaque.  We all smiled.  In fact we laughed  in honor and memory of a man who never complained, was an eternal optimist, cherished each moment of life and was  noted for his infectious, unfettered laugh.

How much more fitting than any stone.

And all of us in attendance heard  his hearty laugh.

ITS NOT WHAT YOU EAT -- ITS HOW MUCH -- News?

News flash--it's not so much what you eat but how much.  In other words calories do count.  There have been attempts among somediet "experts" to emphasize the mix of foods, ie proteins vs carbohydrates vs fats as determining ultimate weight.  But this recent Wall Street Journal article seems to simplifyy matters.   http://online.wsj.com/article/SB10001424052970203462304577138993430777580.html?mod=WSJ_hp_mostpop_read#printMode 

In fact it is much more consistent with the science behind weight gain--namely calories ingested vs calories burned.  Science has always documented the higher calorie count per gram of fat as opposed to protein and carbohydrates.  And there is the added effect of carbohydrates raising blood sugar which in turn stimulates insulin secretion thereby contributing to fat accumulation.

But the article states that all forms of food groups when ingested in excess of bodily needs will ultimately be converted to fat and therefore weight gain.

So it may be valuable to balance the source of calories from among a variety of food sources, but ultimately calories still do count.

 

WHAT PLACEBOS TELL US ABOUT OURSLEVES

A recent Wall Street Journal piece http://online.wsj.com/article/SB1000142405297020472 examined the nature of the placebo effect.  We have touched on this in the past but an up to date review is always welcome.

The conclusion is simply this--the mind has an enormous impact on how disease states affect us.  This is a confirmation of the integration of our thoughts and feelings with our physical body.

What may be less clear is whether placebos produce physical changes in the structure of disease states or just our perception of suffering.

The WSJ article by Shirley S. Wang pointed out that the placebo effect worked even when patients were told they were receiving one.

Of interest was a study in which hotel-room attendants were told that they were getting a good work out lost weight and had lower blood pressure.  In the group who were not told, no changes occurred. Neither group reported changes in diet or exercise.

Even satiety after meals depended upon how many calories the participants were TOLD they consumed rather than the actual amount.  This was not merely a psychological effect.  Serum ghrelin (a gut peptide involved in feelings of satiety)  levels actually changed.

Conditions such as depression and irritable bowel syndrome respond so well to placebos that pharmaceutical companies have difficulty demonstrating their billion dollar drug's effectiveness to the FDA.

When Wang asks whether placebos work on the actual condition or on the perception of success, she quotes Dr. Kaptchuk's work with asthma patients.  He concluded that it was more perceptual than physiologic.

That conclusion is not even consistent with Wang's report itself.  She had already noted that serum ghrelin levels responded to placebo didn't she?

Also the entire field of PNI (psychoneuroimmunology) is based on the notion that psychological factors cause physiologic changes in our body's immune system which are  measurable and quantifiable.  So this is more than perception (not that that is irrelevant either).  

The mind does change the body, as the body affects the mind.

Although chronic stress clearly impairs our immune system through a variety of neurochemical pathways, the good news is that we can do something about it.

Meditation, exercise, prayer, positive affirmations, humor, companionship all alter our state of mind in a positive direction.

Both our personal experiences and experimental science confirm that truth.

"WHATEVER DOESN'T KILL YOU MAKES YOU........" A Successful Survivor

We would all like to believe German philosopher Friedrich Nietzsche's well known assertion, "That which does not kill us makes us stronger."

Unfortunately, those of us who have faced significant adversity (and who hasn't) may find this statement easier said than done.

In many ways we would LIKE to believe it to be true.  It is a sign of strength, self-reliance, resilience.    And it may very well help some of us to assert this to ourselves when we are facing suffering.

But perhaps it is not exactly true.  Many of us have the experience of responding to stressful situations which remind us of past traumas with an exaggerated degree of anxiety.

After 9/11, most of us felt our hearts race when one of the 24hour news stations announced the next news flash.  We may have very well expected another horrific bit of news.

For months after my father passed away I carried my cell phone close to me at all times.  I was subconsciously awaiting the next bit of bad news about his medical condition.

Researchers have recorded neurobiologic correlates on brain scans with victims even years after a traumatic event has passed.  Consciously they may seem fine.  The trauma has left permanent changes.  Our immune systems may be paying the price of decades afterwards.

And yet what choice do we have?  Is it better to continue to play the victim?  Of course not.  After all, we did survive the event.  Are we wounded?  Of course.  But that is true of each and every individual on the planet. 

We are the walking wounded.  But we are also the walking blessed.  We all have wonderful memories and experiences to fall back on.  When we recall them, our immune systems kick up a notch.

So its OK to practice feeling well.  It is OK to recall what has hurt us.  But we also have the right to be proud of who we are--successful survivors.